Analysis and management of cochlear implant explantation in adults.

OBJECTIVES: Cochlear implants have a 10-year manufacturer's warranty and may remain functional for more than 25 years after implantation. With the increasing number of users, the number of explantations is set to increase in the future. The main objective of the present study was to determine reasons for cochlear explantation in adults and the proportion carried out during the warranty period. MATERIAL AND METHODS: A single-centre retrospective multidisciplinary study of cochlear explantation in adults was performed over a 33-month period. Explantation reasons, interval since implantation and warranty application were analysed. RESULTS: 54% of the 71 explantations were for medical reasons, 45% due to failure (35% "hard failure", 10% "soft failure") and 1% could not be classified; 69% were followed by reimplantation. Failure was confirmed before explantation in 66% of cases. Manufacturer warranties were applicable in 70% of explantations for breakdown, for a total of €335,500. CONCLUSIONS: This analysis provides decision support for reimplantation and allows better patient information. Follow-up is essential to optimise warranty application and to promote the proper implant use.

Evaluation of operator radioprotection using a new injection device during vertebroplasty.

This study aimed to evaluate the protection granted by a simple device (X'TENS(®), Thiebaud, France) and to provide operators with information on the performance of this new device, which has not yet been assessed. Our assumption is that this device efficiently reduces the radiation dose to the operator. In a prospective clinical study, the radiation dose the operator's hand receives has been assessed using a specific sensor (UNFOR Instrument). Each patient included in the study was to receive at least two injections of cement during the procedure. Exposure was measured with and without the range extender. The data collected were then processed using a Wilcoxon matched pairs test. During 14 interventions, 20 vertebrae were treated with both procedures. Eleven women and three men were included. Seven patients underwent vertebroplasty for metastatic lesions and seven for osteoporotic lesions, bone fractures or vertebral compressions. The average injection time was 1.35 minutes with the device and 1.20 without (p=0.75). The dose to the hand per ml injected was 111.37 vs. 166.91 (p<0.05). Theoretically, the protection granted by the range extender depends on the length of the device. Our results are consistent with the inverse-square law. However, the variations in our results indicate that a proper and rigorous use is mandatory for the device to be effective. Given that radioprotection during fluoroscopy procedures is a frequently raised issue, the need for information for a safer practice increases likewise.

Results of a comprehensive hospital-based wound survey.

OBJECTIVE: To evaluate the prevalence, clinical aspects and management of wounds in a hospital. METHOD: A one-day survey was undertaken in our university hospital. All hospitalised patients (n=624) were examined. The clinical aspects, aetiology and management (pain, cleansing and primary dressing) of wounds were systematically evaluated. RESULTS: A total of 327 patients (52%) had 933 wounds (mean 2.8 per patient). The prevalence was higher in surgical departments (82%) than medical departments (37%), although wounds in the latter departments were larger, deeper, more painful and less numerous per patient. Pain at wound dressing changes was treated in 89% of cases; antiseptics were used for wound cleansing in 14% of cases; the primary dressing used was appropriate in fewer than 50% of cases in the medical departments. CONCLUSION: This study highlights the high prevalence of wounds in this hospital setting. Many problems with their management have been identified and measures will be taken to optimise care.